What is a Colonoscopy?
A colonoscopy is a test that doctors use to look for and remove adenomas and polyps, growths in the colon that if left untreated may turn into colon or rectal cancer. "This test is also used to screen for colorectal cancer itself."
Colonoscopy is the gold standard in the investigation of the colon and rectum.
In order to undergo a colonoscopy you will need to have laxatives or some other form of medications and a special diet before the investigation is undertaken.
The procedure is usually done in the doctors rooms. Alternatively it could be done in hospital depending on your medical condition.
The procedure is performed using conscious sedation. Your pulse and oxygen saturation levels will be recorded throughout.
Any abnormality in the bowel can be identified and biopsied, or removed at the same time and sent for analysis.
Who needs one?
Everybody by the age of 50 should undergo a complete colonoscopy. At this age the overall risk of the patient developing colorectal cancer starts increasing.
Bowel cancer is the most common internal cancer in South Africa.
Bowel cancer is the second most common cause of death from cancer.
Survival depends on early detection.
Five year survival if the cancer is detected in its early stage is 95%, five year survival in the advanced disease is only 5%.
The lifetime risk in men is 1/20.
The lifetime risk in women is 1/28.
Risk INCREASES with AGE
Family history of bowel cancer is very important in assessing your risk for developing this disease and your need for colonoscopy.
Almost all bowel cancer start as a polyp "in the bowel" and the progression typically takes from five to ten years.
There is a window of opportunity when a bowel polyp can be safely and effectively removed in order to prevent cancer.
Depending on ones family history and past medical history one should have a colonoscopy every five to ten years once the colon is clear in the event of a normal colonoscopy.
There are certain higher risk groups for whom there are specific guidelines.
Specific indications for colonoscopy:
Colonoscopy is the gold standard for investigation of the colon. It is used to examine the entire colon and rectum as well as used to biopsy either inflammation, polyps or tumours or/and to remove polyps or other specific abnormalities.
We know that almost all cancers of the colon and rectum go through a benign stage and thus using colonoscopic polyp removal can reduce the risk of developing cancer and identify those patients who are at risk for developing cancer.
In some advanced areas of the world, colonoscopic screening as been shown to reduce the risk of developing colon or rectal cancer dramatically by up to 70%.
In the vast majority of cases small polyps do not give rise to symptoms and thus these polyps can be removed at colonoscopy and thus cut down the overall risk of the patient developing colorectal cancer.
If cancerous growths are found at colonoscopy it can be biopsied, surgery can then be planned and then the tumour can be removed. The sooner this is done the better the chance the patient has of an overall cure.
High risk groups
The biggest risk factor is age. Approximately 85% of tumours are diagnosed in patients of 60 years or over.
Diet is a risk factor for bowel cancer as are other lifestyle risk factors.
FAMILY HISTORY of bowel cancer is extremely important.
An example of a strong family history of cancer is:
The inherent conditions of FAP (Familial Adenomatous Polyposis) and HNPC this is known as the Lynch syndrome or Hereditary Non-Polyposis Colorectal Cancer.
Preparation for Colonoscopy
Colonoscopy preparation is an important part of the colonoscopy procedure that is usually done at home, following directions given to you in our rooms.
The preparation is often the most uncomfortable part of the whole procedure.
The aim of the colonoscopy preparation is to eliminate all faecal matter from the colon so that we can conduct the colonoscopy with a very clear view of the intestinal wall. We will instruct you to take FOUR Senokot tablets two nights before the procedure in order to start your bowel preparation.
The day before your colonoscopy you may have breakfast before 9h00 in the morning which could consist of toast, egg, cereal, muesli with yoghurt or oats
Thereafter you will be on a fluid diet the rest of the day.
Recommended fluid list: water, black tea or coffee, clear fruit juice such as apple or white grape juice, sprite, strained chicken noodle soup, Bovril in hot water, green or yellow jelly, Energade or Rehydrate.
At midday (12h00) the day before the procedure you start to drink the first of FOUR glasses of Picoprep. You will drink one sachet of Picoprep every two hours until 18h00. We will ask you to drink the four glasses at two hourly intervals so that the last one is usually drunk by 18h00 (6pm).
You will mix one sachet of Picoprep in 250ml of hot water, stir, allow to cool and then drink it. Approximately one to two hours after your first sachet has been drunk you will experience an explosive diarrhea like stool.
It is imperative that you drink a large amount of fluid throughout the time of the preparation to prevent dehydration.
Whilst the Picoprep is being drunk we will require you only to drink clear fluids which can include water, black tea or coffee, clear fruit juice such as apple or white grape juice, sprite, strained chicken noodle soup, Bovril in hot water, green or yellow jelly, Energade or Rehydrate. You may also drink a glass of wine or whisky (not red wine) the evening before the preparation. We advise you to drink at least one glass of water every hour from the start of the preparation.
Costs and Medical Aid
Colonoscopy is almost always done in my consulting/examination rooms in 303 Fairfield Medical Suites.
Your pulse rate, blood pressure and oxygen levels will be monitored and recorded at regular intervals by our nursing sister during your colonoscopy.
The procedure is done in the rooms to exclude the unnecessary costs of hospitalization and anaesthetist fees. If medically indicated your colonoscopy may be done in hospital.
The majority of medical aids will cover part or all of your costs of your colonoscopy.
You will need pre-authorisation from your medical aid and the practice will assist you with any information you may require. (Forms and codes will be giving to you when you make the appointment).
Frequently Asked Questions
NB! If you have allergies to any medications please notify the staff, physician and other arrangements will be made if necessary.
It is imperative that you inform the secretary when making your appointment for your colonoscopy if you have a cardiac pacemaker or artificial valves or stents.
You cannot leave without an adult to escort you home and you may not drive a car for a period of twelve hours after the colonoscopy.
Ecotrin/Disprin must be stopped at least five days before the procedure.
The instance of perforation of the colon in this practice is less than 0.01%.
For more information about Colonoscopy, please contact Dr Michael Elliot.